Growth surveillance in the context of the Primary Public Healthcare Service Network in Brazil: literature review

Pedraza, Dixis Figueroa

doi:10.1590/1806-93042016000100002

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Revista Brasileira de Saúde Materno Infantil

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REVIEW • Rev. Bras. Saude Mater. Infant. 16 (1) • Jan-Mar 2016 • https://doi.org/10.1590/1806-93042016000100002 copy

Growth surveillance in the context of the Primary Public Healthcare Service Network in Brazil: literature review

Vigilância do crescimento no contexto da Rede Básica de Saúde do SUS no Brasil: revisão da literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to identify and analyze the scientific literature on child growth monitoring in the context of the primary public healthcare service network in Brazil, focusing on the main problems detected in studies.

Methods:

the review was based on searches ofSciELO, Lilacs and PubMed databases to identify articles published between 2006 and 2014. The articles were categorized according to the analytical categories of structure (items needed to carry out primary activities) or work processes (set of activities and procedures used in the management of resources).

Results:

of the 16 articles included in this review, only six dealt with structure and, in these, thetraining of professionals and availability of protocols were the most frequently identified problems. Processes, addressed in 15 articles, highlighted the underutilization of Child Health Handbook to record growth measurements and the adoption of guidelines on the basis of notes taken.

Conclusions:

the difficulties found demonstrate the everyday circumstances of the public health service which have a detrimental effect on growth surveillance.

Key words:
Primary health care; Health services evaluation; Nursing care; Community medicine; Nutritional surveillance

Exclusion and inclusion criteria		Number of studies
Studies identified (data bases)
	SciELO	492
	Lilacs	711
	PubMed	1093
	Duplicate studies (in two databases)	423
	Triplicate studies (in three databases)	128
	Total studies identified	1745

Excluded studies
Screening Phase
	-Publications of other nature (different articles)	74
	-Studies outside Brazil	82
	-Review studies	70
	-Intervention studies	53
	-Qualitative research	66

Reading stage of the methods section or in full
	-Studies that did not include children under five years	467
	-Studies not carried out in the basic SUS health network	601
	-Studies not focused on child growth monitoring	314
	-Studies that included only compound parameters	02
	Total studies excluded	1729
	Total articles included	16

Author, year	Objectives	Study site	Subjects and sample
Palombo CNT et al .,¹⁶16 Palombo CNT, Duarte LS, Fujimori E, Toriyama ATM. Uso e preenchimento da caderneta de saúde da criança com foco no crescimento e desenvolvimento. Rev Esc Enferm USP. 2014; 48 (Esp): 60-7.2014	Evaluate the use and completion of CHR, especially growth and development in BHU	Small-size municipality, SP	12 BHU
		Small-size municipality, SP	358 children under three years and their CHR

Costa JSD et al .,¹⁷17 Costa JSD, Cesar JA, Pattussi MP, Fontoura LP, Barazzetti L, Nunes MF, Gaedke MA, Uebel R. Assistência à criança: preenchimento da caderneta de saúde em municípios do semiárido brasileiro. Rev Bras Saúde Matern Infant. 2014;14 (3): 219-27. 2014	To check the quality of health care by investigating the CHR frequency with adequate completion and confirm its association with possible explanatory variables in two cities of the semiarid region of northeastern Brazil	Caracol and Anísio de Abreu, PI	342 children under three years and their CHR

Furtado MCC et al .,¹⁸18 Furtado MCC, Braz JC, Pina JC, Mello DF, Lima RAG. A avaliação da atenção à saúde de crianças com menos de um ano de idade na Atenção Primária. Rev Latino Am Enfermagem. 2013; 21 (2): 1-8. 2013	To analyze the presence and extent of the attributes of primary care and the degree of affiliation of children under one year of age in a BFHU	São Paulo, SP	1 BFHU
		São Paulo, SP	44 children under one year

Moreira MDS et al .,¹⁹19 Moreira MDS, Gaíva MAM. Acompanhamento do crescimento e desenvolvimento infantil: análise dos registros das consultas de enfermagem. Pesq Cuid Fundam Online. 2013;5 (2): 3757-66. 2013	Describe the growth and development records made by nurses in nursing consultation for children under two years at BFHU	Cuiabá, MT	4 BFHU
		Cuiabá, MT	22 medical records and CHR

Rocha ACD et al .,²⁰20 Rocha ACD, Pedraza DF. Acompanhamento do crescimento infantil em unidades básicas de saúde da família do município de Queimadas, Paraíba, Brasil. Texto Contexto Enferm. 2013; 22 (4): 1169-78. 2013	Evaluate growth monitoring actions in the context of primary health care in the municipality of Queimadas, Paraíba, Brazil highlighting structural and procedural aspects	Queimadas, PB	16 BFHU
		Queimadas, PB	204 childrenbornduring 2009

Reichert APS et al .,²¹21 Reichert APS, Almeida AB, Souza LC, Silva MEA, Collet N. Vigilância do crescimento infantil: conhecimento e práticas de enfermeiros da atenção primária à saúde. Rev Rene. 2012; 13 (1): 114-26. 2012	Check the knowledge and practices of FHS nurses as to growth monitoring of infants during routine childcare and maternal information	João Pessoa, PB	53 BFHU
		João Pessoa, PB	45 nurses 225 children under two years

Costa GD et al .,²²22 Costa GD, Cotta RMM, Reis JR, Ferreira MLSM, Reis RS, Franceschini SCC. Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil). Ciênc Saúde Colet. 2011; 16 (7): 3229-40. 2011	Evaluate the health care of the child by FHP taking distinct scenarios as reference	Teixeiras, MG	4 BFHU
		Teixeiras, MG	35 health professionals 161 children under two years

Saparolli ECL et al .,²³23 Saparolli ECL, Adami NP. Avaliação da estrutura destinada à consulta de enfermagem à criança na atenção básica. Rev Esc Enferm USP. 2010; 44 (1): 92-8. 2010	Assess the quality of the structure available for the nursing consultation given to children under one year of age at BFHU in São Paulo	São Paulo, SP	8 BFHU
		São Paulo, SP	12 offices intending to implement the nursing consultation 14 Nurses

Caldeira AP et al .,²⁴24 Caldeira AP, Oliveira RM, Rodrigues OA. Qualidade da assistência materno-infantil em diferentes modelos de Atenção Primária. Ciênc Saúde Colet. 2010; 15 (Supl. 2): S3139-47. 2010	Assess the quality of maternal and child care in two models of care (FHS vs. Traditional)	Montes Claros, MG	595 children under two years (297 FHS vs. 298 traditional)

Lima MAAL et al .,²⁵25 Lima MAA, Oliveira MAA, Ferreira HS. Confiabilidade dos dados antropométricos obtidos em crianças atendidas na Rede Básica de Saúde de Alagoas. Rev Bras Epidemiol. 2010; 13 (1): 69-82. 2010	Investigate whether anthropometric data produced in the basic Brazilian Health System in Alagoas have satisfactory reliability	State of Alagoas	40 BHU
		State of Alagoas	347 children under five years

Lima GGT et al .,²⁶26 Lima GGT, Silva MFOC, Costa TNA, Neves AFGB, Dantas RA, Lima ARSO. Registros do enfermeiro no acompanhamento do crescimento e desenvolvimento: enfoque na consulta de puericultura. Rev Rene. 2009; 10 (3): 117-24. 2009	Analyze whether the growth and development records of children within the basic network nursing consultation context are in agreement with the proposal of the Ministry of Health	João Pessoa, PB	1 BHU
		João Pessoa, PB	39 medical records of children aged 0-12 months

Alves CRL et al .,²⁷27 Alves CRL, Lasmar LMLBF, Goulart LMHF, Alvim CG, Maciel GVR, Viana MRA, Colosimo EA, Carmo GAA, Costa JGD, Magalhães MEN, Mendonça ML, Beirão MMV, Moulin ZS. Qualidade do preenchimento da Caderneta de Saúde da Criança e fatores associados. Cad Saúde Pública. 2009; 25 (3): 583-95. 2009	To analyze the factors associated with quality of CHRcompletion in Belo Horizonte	Belo Horizonte, MG	18 BHU
		Belo Horizonte, MG	365 CHR of children under one year

Carvalho MF et al .,²⁸28 Carvalho MF, Lira PIC, Romani SAM, Santos IS, Veras AACA, Batista Filho M. Acompanhamento do crescimento em crianças menores de um ano: situação nos serviços de saúde em Pernambuco, Brasil. Cad Saúde Pública. 2008; 24 (3): 675-85. 2008	Analyze the growth monitoring action of children under one year at BHU in the State of Pernambuco, Brazil, in 1998, in relation to structure and process	State of Pernambuco	120 BHU
		State of Pernambuco	816 children under one year

Frota MA et al .,²⁹29 Frota MA, Pordeus AMJ, Forte LB, Vieira LJES. Acompanhamento antropométrico de crianças: o ideal e o realizado. Rev Baiana Saúde Pública. 2007; 31 (2): 212-22. 2007	To assess factors related to weight anthropometric monitoring by health professionals	Fortaleza, CE	4 BHU
		Fortaleza, CE	20 health professionals (11 pediatricians and nine nur ses)

Saparolli ECL,³⁰30 Saparolli ECL, Adami NP. Avaliação da qualidade da consulta de enfermagem à criança no Programa de Saúde da Família. Acta Paul Enferm. 2007; 20 (1): 55-61. 2007	To assess the quality of nursing consultations given to children under one year of age at BFHU in São Paulo	São Paulo, SP	8 BHU
		São Paulo, SP	14 nurses and 114 consultations to children under one year of age

Prado SRLA,³¹31 Prado SRLA, Fujimori E. Registro em prontuário de crianças e a prática da integralidade. Rev Bras Enferm. 2006; 59 (1): 67-71. 2006	To assess medical records from two health units, one in the FHS model and another traditional	São Paulo, SP	1 BFHU
			1 BHU
			195 records of health facilities related to children aged 0-5 years (99 FHS vs. 96 traditional)

Author, year	Main results
Rocha ACD et al .,²⁰20 Rocha ACD, Pedraza DF. Acompanhamento do crescimento infantil em unidades básicas de saúde da família do município de Queimadas, Paraíba, Brasil. Texto Contexto Enferm. 2013; 22 (4): 1169-78. 2013	-18.7% of units without all members of the minimum team
	-6.3% of units without nutritionist and pediatric support at FHSC
	-100% of units with equipment to measure children
	-6.3% of units without equipment to weigh children
	-6.3% of the units without CHR availability
	-62.5% of nurses untrained in growth monitoring actions
	-25% of nurses do not use growth monitoring protocols

Reichert APS et al .,²¹21 Reichert APS, Almeida AB, Souza LC, Silva MEA, Collet N. Vigilância do crescimento infantil: conhecimento e práticas de enfermeiros da atenção primária à saúde. Rev Rene. 2012; 13 (1): 114-26. 2012	-28.9% of the nurses without knowledge of the risk factors for stunting
	-62.2% nurses without knowledge of the growth process
	-64.4% of the nurses without knowledge of the growth curves contained in CHR

Costa GD et al .,²²22 Costa GD, Cotta RMM, Reis JR, Ferreira MLSM, Reis RS, Franceschini SCC. Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil). Ciênc Saúde Colet. 2011; 16 (7): 3229-40. 2011	-Poor and old facilities and hygiene problems
	-Care rooms with no sinks
	-Presence of Pediatric scale
	-Lack of protocols and standards related to growth

Saparolli ECL et al .,²³23 Saparolli ECL, Adami NP. Avaliação da estrutura destinada à consulta de enfermagem à criança na atenção básica. Rev Esc Enferm USP. 2010; 44 (1): 92-8. 2010	-Mostly satisfactory conditions of offices
	-Two offices without sinks
	-100% of offices with material resources (pediatric scale, table for pediatric scale, anthropometric ruler, anthropometric tape)

Lima MAAL et al .,²⁵25 Lima MAA, Oliveira MAA, Ferreira HS. Confiabilidade dos dados antropométricos obtidos em crianças atendidas na Rede Básica de Saúde de Alagoas. Rev Bras Epidemiol. 2010; 13 (1): 69-82. 2010	-40% of BHU with suitable locations to perform anthropometry
	-Platform scale in 97.5% of units
	-Pediatric Balances in 85% of the units, the majority (73.5%) in poor maintenance conditions
	-Estadiometer in 27.5% of the units, of which 36.4% in poor conservation status
	-Anthropometric tape in 25% of units
	-18% of professionals with training in anthropometry
	-13% of professionals with training in CHR management

Carvalho MF et al .,²⁸28 Carvalho MF, Lira PIC, Romani SAM, Santos IS, Veras AACA, Batista Filho M. Acompanhamento do crescimento em crianças menores de um ano: situação nos serviços de saúde em Pernambuco, Brasil. Cad Saúde Pública. 2008; 24 (3): 675-85. 2008	-15.8% of units without or with insufficient CHR
	-Pediatric Balance operating in 84.2% of units
	-Program Standards (growth monitoring) in 24.6% of units
	-75.3% of physicians and 51.2% of nurses untrained in growth monitoring actions

Author, year	Main results
Palombo CNT et al .,¹⁶16 Palombo CNT, Duarte LS, Fujimori E, Toriyama ATM. Uso e preenchimento da caderneta de saúde da criança com foco no crescimento e desenvolvimento. Rev Esc Enferm USP. 2014; 48 (Esp): 60-7. 2014	-8.9% of CHR with records in the weight and height curves
	-83.7% of mothers counseled on child's weight gain and stature

Costa JSD et al .,¹⁷17 Costa JSD, Cesar JA, Pattussi MP, Fontoura LP, Barazzetti L, Nunes MF, Gaedke MA, Uebel R. Assistência à criança: preenchimento da caderneta de saúde em municípios do semiárido brasileiro. Rev Bras Saúde Matern Infant. 2014;14 (3): 219-27. 2014	-29.2% of CHR with no weight record

Furtado MCC et al .,¹⁸18 Furtado MCC, Braz JC, Pina JC, Mello DF, Lima RAG. A avaliação da atenção à saúde de crianças com menos de um ano de idade na Atenção Primária. Rev Latino Am Enfermagem. 2013; 21 (2): 1-8. 2013	-Most mothers reported receiving information about feeding and growth changes in all medical or nursing consultations

Moreira MDS et al .,¹⁹19 Moreira MDS, Gaíva MAM. Acompanhamento do crescimento e desenvolvimento infantil: análise dos registros das consultas de enfermagem. Pesq Cuid Fundam Online. 2013;5 (2): 3757-66. 2013	-CHR showed weight, height, head circumference and BMI records of 100%, 100%, 72.7% and 22.7%, respectively

Rocha ACD et al .,²⁰20 Rocha ACD, Pedraza DF. Acompanhamento do crescimento infantil em unidades básicas de saúde da família do município de Queimadas, Paraíba, Brasil. Texto Contexto Enferm. 2013; 22 (4): 1169-78. 2013	-38.7% of children with no weight record in the last three months at CHR
	-33.8% of children with no height record in the last three months at CHR
	-17.6% of children without at least two weight records in the weight x age curve of CHR

Reichert APS et al .,²¹21 Reichert APS, Almeida AB, Souza LC, Silva MEA, Collet N. Vigilância do crescimento infantil: conhecimento e práticas de enfermeiros da atenção primária à saúde. Rev Rene. 2012; 13 (1): 114-26. 2012	-95.6% of nurses reported performing growth monitoring consultation, 97.8% advise the mothers on child's weight and 100% advise on child's feeding
	-100% of children with growth assessment
	-54.7% of mothers without guidance on the weight curve of CHR
	-14.2% of mothers unguided about infant feeding

Costa GD et al .,²²22 Costa GD, Cotta RMM, Reis JR, Ferreira MLSM, Reis RS, Franceschini SCC. Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil). Ciênc Saúde Colet. 2011; 16 (7): 3229-40. 2011	-22.8% of children without CHR
	-100% of incomplete CHR (no growth curve on the graph, no information on weight and height)

Caldeira AP et al .,²⁴24 Caldeira AP, Oliveira RM, Rodrigues OA. Qualidade da assistência materno-infantil em diferentes modelos de Atenção Primária. Ciênc Saúde Colet. 2010; 15 (Supl. 2): S3139-47. 2010	-Regular record of growth and development in 75.8% of cases in the FHS vs. 48.3% in traditional services with better performance in the FHS (significant difference)

Lima MAAL et al .,²⁵25 Lima MAA, Oliveira MAA, Ferreira HS. Confiabilidade dos dados antropométricos obtidos em crianças atendidas na Rede Básica de Saúde de Alagoas. Rev Bras Epidemiol. 2010; 13 (1): 69-82. 2010	-15% of professionals reported following specific procedures for weight and height collection
	-100%, 26% and 38% of professionals reported recording anthropometric data in the medical
	record, nutritional surveillance form and CHR, respectively
	-100% of children with weight measurement
	-25.1% of children with height measurement
	-91.1 % of children with weight measurement in the medical record
	-13.3% of children with weight records at CHR
	-87.7 % of children with height measurements in the medical records

Lima GGT et al .,²⁶26 Lima GGT, Silva MFOC, Costa TNA, Neves AFGB, Dantas RA, Lima ARSO. Registros do enfermeiro no acompanhamento do crescimento e desenvolvimento: enfoque na consulta de puericultura. Rev Rene. 2009; 10 (3): 117-24. 2009	-30.8% of children with no weight record
	-38.5% of children with no height record
	-35.9% of children with no head circumference record

Alves CRL et al .,²⁷27 Alves CRL, Lasmar LMLBF, Goulart LMHF, Alvim CG, Maciel GVR, Viana MRA, Colosimo EA, Carmo GAA, Costa JGD, Magalhães MEN, Mendonça ML, Beirão MMV, Moulin ZS. Qualidade do preenchimento da Caderneta de Saúde da Criança e fatores associados. Cad Saúde Pública. 2009; 25 (3): 583-95. 2009	-38.9% of mothers without information on the weight x age curve
	-Correct record of birth weight, birth length and head circumference at birth of 94.1%, 91.2% and 85.6%, respectively
	-Correct record of birth weight, birth length and head circumference at birth of 69.3%, 15.5% and 59.4%, respectively

Carvalho MF et al .,²⁸28 Carvalho MF, Lira PIC, Romani SAM, Santos IS, Veras AACA, Batista Filho M. Acompanhamento do crescimento em crianças menores de um ano: situação nos serviços de saúde em Pernambuco, Brasil. Cad Saúde Pública. 2008; 24 (3): 675-85. 2008	-53.1% of children with weight measurement
	-21% of children with height measurement
	-89.4% of CHR with birth weight record
	-44.1% of CHR with weight record at birth on the curve
	-58.2% of children with weight records at CHR
	-43.2% of parents guided about growth curves (weight), 35.5% on weight and 53.5% on stature
	-On first consultation, 54.3% of children were weighed, 20.2% were measured, 22.4% with weight on the curve and 21.5% with guidelines on growth

Frota MA et al ., ²⁹29 Frota MA, Pordeus AMJ, Forte LB, Vieira LJES. Acompanhamento antropométrico de crianças: o ideal e o realizado. Rev Baiana Saúde Pública. 2007; 31 (2): 212-22. 2007	-75% of professionals reported recording weight on the curve at every visit
	-60% of professionals reported providing guidance to parents about growth curves

Saparolli ECL,³⁰30 Saparolli ECL, Adami NP. Avaliação da qualidade da consulta de enfermagem à criança no Programa de Saúde da Família. Acta Paul Enferm. 2007; 20 (1): 55-61. 2007	-100% of children with weight and height measurement
	-79.8% of children with head circumference measurement, of which 9.8% on the curve
	-96.7% of children with adequacy in weighing procedures
	-90.4% of children with adequacy in measuring procedures
	-86% of children with weight and height records in the medical records
	-100% of next appointment scheduling

Prado SRLA,³¹31 Prado SRLA, Fujimori E. Registro em prontuário de crianças e a prática da integralidade. Rev Bras Enferm. 2006; 59 (1): 67-71. 2006	-Record, respectively, of weight and height, in 97.9% and 95.9% of cases in the FHS model unit vs . 91.8% and 89.7% in the traditional model unit, with no significant difference
	-Record on the growth curve in 92.9% of cases in the FHS model unit vs . 8.3% in the traditional model unit, with significant difference

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[TFN01] BFHU= Basic Family Health Unit; BHU= Basic Health Unit; CHR= Child Health Record; FHP= Family Health Program; FHS= Family Health Strategy